Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial

Abstract

ObjectiveUltrasound-guided lateral thoracolumbar interfascial plane block (US-TLIP block) is a novel regional technique for anesthesia or analgesia. However, there has been no prospective, randomized and controlled clinical trial investigating the perioperative analgesic effect of US-TLIP block on lumbar spinal fusion surgery. The aim of this study was to investigate the analgesic effect of bilateral single-shot US-TLIP in patients undergoing lumbar spinal fusion surgery.MethodsA prospective and randomized comparative clinical study was conducted. A total of 60 patients (ASA classes: I–II), aged 21–74 years who were scheduled for lumbar spinal fusion surgery were randomized and divided into the TLIP group (Group T, n = 30) and control group (Group C, n = 30). The patients in Group T received preoperative bilateral single-shot US-TLIP with 30 ml of 0.375% ropivacaine at the third lumbar spine (L3) vertebral level, and the patients in Group C received an injection of 30 ml 0.9% saline through same technique. All patients received patient-controlled analgesia (PCA) after their operation. The frequency of PCA compressions and rescue analgesic administrations were recorded. Opioids (sufentanil and remifentanil), anesthetic consumption, the number of postoperative days spent in a hospital bed, overall hospital stay time and postoperative complications were recorded. The Visual Analogue Scale (VAS) and Bruggemann Comfort Scale (BCS) scores for pain and comfort assessment were recorded at 1, 12, 24, 36, and 48 hours postoperatively.ResultsOpioids and anesthetic consumption in the perioperative period decreased significantly in the TLIP group compared to the control group (P < 0.05). The VAS and BCS scores in the TLIP group were lower at 12, 24, and 36 hours postoperatively (P < 0.05). US-TLIP block has been shown to shorten postoperative hospital stays (P < 0.05). There was no significant difference in postoperative complications between the two groups.ConclusionOur study findings show that bilateral US-TLIP block exhibits significant analgesia and safety in patients undergoing lumbar spinal fusion surgery.

Thoracolumbar interfascial plane block for postoperative analgesia in spine surgery: A systematic review and meta-analysis

“…The methodological quality of the involved trials is shown in Figs 2 and 3 . 6 studies compared TLIP block with non-block care [ 10 , 12 , 15 , 16 , 18 , 20 ], 3 studies compared TLIP block with wound infiltration [ 11 , 17 , 19 ].…”

“…Across all studies, 8 studies were analyzed postoperative pain intensity with the use of TLIP block in patients receiving spine surgery [ 10 – 12 , 15 – 18 ].…”

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

“…Regarding regional plane blocks, different techniques have been described in spinal surgery (erector spinae plane block, quadratus lumborum, thoraco-lumbar interfacial plane [TLIP] block). Only the TLIP block has been evaluated for lumbar fusion: in a randomized, double-blind placebo-controlled trial, the TLIP block significantly reduced analgesic drug consumption at 24 and 48 hours, pain, and LOS without complications [181].…”

Bibliometric evaluation of ultrasound in orthopaedics&nbsp;global publications: 10-year trends and&nbsp;hotspots

“…For example, the rate of urinary calculi surgery has dropped because of the use of ultrasonic lithotripsy technique (6). The use of ultrasound-guided lateral thoracolumbar interfascial plane block also reduces the pain of lumbar spine fusion surgery patients (7).…”